Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, PA.
Center for Human Development, UC San Diego, La Jolla, CA.
J Pediatr. 2022 Feb;241:115-125.e2. doi: 10.1016/j.jpeds.2021.09.030. Epub 2021 Sep 25.
To identify predictors of changes in height, weight, and body mass index (BMI) in children with attention deficit hyperactivity disorder (ADHD) starting central nervous system (CNS) stimulants.
There were 230 medication-naïve children aged 5-12 years with ADHD who participated in a randomized trial evaluating the impact of CNS stimulants on growth over 30 months. This observational analysis focused on the 141 participants using study medication for 65 or more days in the first 6-months after starting medication. Biometric variables, ADHD, and oppositional defiant disorder symptom scores at medication initiation, and medication use over the study were examined as predictors of changes in standardized (z) height, weight, and BMI.
Mean changes in z-BMI, z-weight. and z-height were negative throughout the study. The most consistent predictors of change in z-BMI, z-weight, and z-height were percent days medicated and total medication exposure. Children with lower z-height and z-weight at medication initiation experienced greater z-BMI and z-weight decreases over the first 6 months on medication. Greater appetite suppression during dose optimization predicted greater decreases in z-weight over the entire study and a greater decrease in z-height over the first 6 months on medication. z-weight change correlated with z-height change. Behavioral symptoms did not predict changes in z-BMI, z-weight, or z-height.
How much and how often CNS stimulants are used predicts changes in z-BMI, z-weight, and z-height in children. Even smaller and lighter children may be at risk for decreases in z-weight and z-BMI. Parent ratings of appetite during dose titration may serve as feasible indicators of future weight and height change in children using CNS stimulants.
Clinicialtrials.gov: NCT01109849.
确定开始使用中枢神经系统（CNS）兴奋剂的注意缺陷多动障碍（ADHD）儿童身高、体重和体重指数（BMI）变化的预测因素。
共有 230 名 5-12 岁未接受过药物治疗的 ADHD 儿童参加了一项随机试验，评估 CNS 兴奋剂对 30 个月内生长的影响。这项观察性分析主要关注在开始用药后 6 个月内使用研究药物超过 65 天的 141 名参与者。在开始用药时的生物测量变量、ADHD 和对立违抗性障碍症状评分以及研究期间的用药情况被检查为标准化（z）身高、体重和 BMI 变化的预测因素。
整个研究过程中 z-BMI、z 体重和 z 身高的变化均为负值。变化预测最一致的因素是用药比例和总用药暴露。在开始用药时 z 身高和 z 体重较低的儿童，在用药的前 6 个月内 z-BMI 和 z 体重的下降幅度更大。在剂量优化期间，食欲抑制程度越大，整个研究期间 z 体重的下降幅度越大，在用药的前 6 个月内 z 身高的下降幅度越大。z 体重的变化与 z 身高的变化相关。行为症状不能预测 z-BMI、z 体重或 z 身高的变化。
CNS 兴奋剂的使用量和使用频率预测了儿童 z-BMI、z 体重和 z 身高的变化。即使是身材较小和较轻的儿童，也可能面临 z 体重和 z-BMI 下降的风险。在剂量调整期间，家长对食欲的评价可能是使用 CNS 兴奋剂的儿童未来体重和身高变化的可行指标。
Clinicialtrials.gov：NCT01109849。
